Poster Evaluation Form

Avoiding cardiopulmonary bypass during extracardiac Fontan operation carries potential benefits. We present a case report of extracardiac off-pump Fontan in a 6-year-old girl with univentricular heart. To the best of our knowledge, this is the first extracardiac off-pump Fontan procedure in Indonesia.

We present a case of 6 years old girl with tric`uspid atresia, ventricular septal defect, and pulmonary stenosis who previously underwent central shunt in 2017 and bidirectional cavopulmonary (Glenn) shunt in 2019. We successfully did extracardiac conduit Fontan operation without cardiopulmonary bypass. A Gore-Tex conduit was anastomozed to the inferior surface of right pulmonary artery using vascular clamp. Meanwhile, inferior vena cava to conduit anastomosis was performed with passive IVC decompression between IVC and right atrium.

The patient was extubated within 16 hours. However, duration of chest tube drainage was 24 days due to small amount chylothorax. On the 1 month follow up, the patient had a patent Fontan circuit without recurrent pleural effusion.

Performing extracardiac off-pump Fontan operation is reported to result in better outcomes. Although the technique may be challenging, however we recommend to attempt the technique whenever possible to eliminate the adverse effects.

Following Fontan procedure, patients are at risk of experiencing thromboembolic events due to various factors stemming from the univentricular cardiac system. To mitigate the risk of thromboembolism, patients are typically administered post-operative anticoagulant treatment. However, a consensus regarding the optimal anticoagulant therapy for preventing thromboembolic events in post-Fontan surgery patients has yet to be established.

A literature search was performed across five electronic databases: MEDLINE, EBSCO, ProQuest, Scopus, and the Cochrane Library, to identify relevant studies. The selection of studies for examination was carried out through the removal of duplicate articles, screening of titles and abstracts, and a final selection involving comprehensive review of all the articles screened based on predefined eligibility criteria. A critical appraisal was then performed on the selected studies using the FAITH worksheet for meta-analysis studies.

Following an extensive literature search and meticulous selection, two meta-analysis studies were selected. While the overall validity of both studies is satisfactory, certain aspects of validity criteria were not met in both meta-analyses, notably the absence of an explanation regarding the critical appraisal tools used and the quality of studies included in the meta-analyses. Significantly, both studies showed that the utilization of aspirin or warfarin reduced thromboembolic events in post-Fontan procedure patients when compared to those without anticoagulant therapy (IRR 0.23-0.24 and OR 0.363-0.425; 95% CI; p 0.05).

Administration of both aspirin and warfarin can effectively reduce thromboembolic events in post-Fontan procedure patients. Data from two meta-analysis studies showed no significant difference were identified between aspirin and warfarin with regard to the prevention of thromboembolic events. Thus, aspirin stands as a viable alternative to warfarin for preventing thromboembolic incidents in patients who have undergone Fontan procedure.

A stenosis of a large intrathoracic vein is referred to central venous stenosis frequently injured from intravascular device insertion.The purpose of this study focus on the effectiveness of endovascular therapy in routine hemodialysis patients with central venous stenosis with the goal is establishing endovascular intervention for the treatment of CVS.

To ensure comprehensive retrieval of relevant research we will search the following key databases: PubMed, Cochrane Library, and Proquest through 2013 for peer reviewed articles containing evidence related to endovascular therapy in routine hemodialysis patients with central vein stenosis.

Endovascular intervention is the first-line treatment for CVS because it is less invasive and can both maintain vascular access patency and reduce symptoms. Following management, the symptoms of venous hypertension were alleviated. There were no serious complications or mortality during the procedure. Percutaneous transluminal angioplasty (PTA) has a technical success rate ranging from 70% to 90%. The failure of the method could be attributed mostly to the pathophysiology of the lesion. In some obstruction cases, regardless of the extent of the lesion, passing through the lesion with standard wire is difficult. At one year, the secondary patency rate in the PTA group was (48.6±18.7)% and in the stent group was (83.3±15.2)%.

In the short term, endovascular intervention is a safe and effective approach for treating CVS. To sustain patency over time, enhanced follow-up and recurrent interventions are essential.